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on november the 27, it specifically mentions a section, 1311 of aca, which directs quality health plan issues and improvement strategies as directed by the secretary, specifically subsection 8 of 1311 would allow the secretary to prevent physicians treating patients in exchanges unless they implement such mechanisms to improve health care quality the secretary may require. physicians must follow quality directives as defined by the secretary or lose their business. mr. smith, are you aware of this provision? >> i am not familiar with that section. >> let me ask you this. in this provision, you may not know this either, but the word quality is not defined in the statute. it is safe to assume that the secretary, not just secretary sebelius, but every secretary to follow, would be able to define for regulation what that word quality means. yes or no? >> i believe that is the correct interpretation. again, we have tried to introduce quality performances into a variety of parts of our programs, both in managed care, both in the fee-for-service world, and this is another one of our concerns that we
a loss so vast. the aca is not just above the expansion of medicaid or establishing an insurance exchange, it is about the hundreds of federal mandates and procedural requirements that have the escaped public attention, but to which we by law must obey. the fine print of the legislation is so complex, even the federal government struggles to understand it. the states cannot fully understand the impact on finances, systems changes, and operations. this law completely overwhelms society's safety net for the needy. there are a few problems in pennsylvania created by the aca. the law mandates that we expand our provider enrollment system to check with their medicare data. medicare databases cannot handle automated changes. we will have to add staff resources to respond to 100,000 inquiries every month. we are mandated to create separate databases to accommodate is exchanges and some databases like the masterfile, we have not been given access to. we adopt past medicaid rules radically changing the tailor- made renewal system that took years to refine and perfect. the verification system will
is the creation of health care exchanges. now, let me explain. these aca exchanges are online marketplaces. in short, websites. the idea is to force insurance companies to play by the same rules and compete for a large pool of customers resulting in less expensive premiums for everyone. here's how it works. let's say you're one of the 50 million people in in country without health care. you're looking to get yourself covered. you'd log on to your state's exchange or call a hotline number. the goal is to shop around for whatever plan works best for you and your family. if you are living at 138% to 400% of the poverty line, that is a family of four living off an annual income of $31,809 to $92,200, then you are eligible for government money to subsidize the cost of your premium. if you're above that level, you don't get the federal subsidy. the law requires every state to have a place for people to shop for coverage. there are three options on how they are created and operated. >> first, states can set up and run their own exchanges or if they're not quite ready to tackle is on their own, st
that must be covered by any health plan offering a plan in the aca exchange. i understand this has far reaching consequences on premiums. benefits must be provided. according to the notice in the federal register, the rule was approved by administrator on august 1, 2012. that is three months before. yet the role did not receive approval from secretary sebillius until two weeks ago. what did it take two month for the administration staff to review -- and yet the public will have only four weeks to review during the period of public comment on the ruling issued on november 26? i would note this is a time of year when people's focus is generally on things other than long awaited rules. >> we put a bulletin on the essential health benefits quite some time ago and got comments on the bulletin. the public had an opportunity to provide public comment on essential health benefits before the proposed rule was put out. there were some changes from what had been in the bulletin, but by and large what is in the bulletin is what is a in the proposed rule. i think there has been ample opportunity fo
will get even higher. >> but that is the point now that you have the aca that you can have this discussion in a way that was much harder to have before. it is really saying for those who are able to continue working, can we begin to reorient the expectation for the next generation, which is what we're talking about, recognizing that for people who are in that pre now pre-medicare age, they will no longer have to postpone taking care of health care because they, in fact, have an option. so it is why this discussion takes on a whole different tone as a result of the affordable care act having passed. >> i mean, i would say we have options, but we don't know if they're affordable options, and that's really the big difference. >> al milliken, am media. what can we learn from other countries? i'm wondering if any of you have studied the health benefit programs elsewhere, and do any have comparable insurance programs, and what has been the experience in other nations? >> most of them are struggling mightily with the promises they have made which encourage people to retire even earlier than they
to be sicker and therefore the cost will be would hire. >> that is appointed the aca that you have this discussion in a way that is much harder to have before. it is really saying, for those who are able to continue working, can we begin to re-orient and the expectation for the next generation which is what we are talking about, recognizing that for people who are in that now pre-medicare age, they will no longer have to postpone health care because they have options. it is why this discussion takes on a whole different tone as a result. >> i would say we have options that we don't know if they are affordable options and that is really the big difference. >> i will milliken, a immediate. what can we learn from other countries? i am wondering if any of you have studied the health benefit programs elsewhere and do any have comparable insurance programs in what has been the experience in other nations? >> most of them are struggling muddling with the promises they have made which encourage people to retire even earlier than they do in the united states and finding themselves in very s
Search Results 0 to 6 of about 7 (some duplicates have been removed)